Most colleagues in primary care will be aware of Public Health England’s current cervical screening campaign, which started on 5 March.
The campaign highlights the NHS Cervical Screening Programme which has made a significant impact on cervical cancer mortality since it was established in 1988, saving an estimated 5,000 lives a year. However the uptake in the screening programme has declined in the last decade with current coverage is at a 20-year low and the programme is not meeting its 80% coverage standard. It is because of these concerns that the campaign was started.
More information is in this letter I wrote with Cally Palmer, National Cancer Director at NHS England.
Campaign resources
All GP practices in England should have received a resource pack in late February. Further resources can be downloaded from the PHE Campaign Resource Centre.
My GP colleague Dr Jim McMorran has said:
The campaign will hopefully encourage more women to participate in the screening programme and so reduce their cancer risk; with a consequent increase in women contacting our surgeries for smears.
I know that capacity is an issue but am very grateful for all you are doing to accommodate as many women as possible.
Screening helpdesk does not have access to results
Please do not point women to the PHE Screening helpdesk with queries about results.
PHE does not have access to patient records so all the helpdesk can do is direct the women back to their GP, which inevitably causes frustration on all sides and doesn’t assist with access to screening tests.
You should be able to find a woman’s cervical screening history on your local practice IT system, or else on the Open Exeter System run by Primary Care Support England (PCSE). You should contact PCSE with any queries.
Opting out and women with symptoms
As ever, I would stress that screening is a choice and that while I hope the campaign will encourage women to be screened, those who make an informed decision to opt out should never be put under pressure to change their mind.
And for women under 25 showing any symptoms of cervical cancer, screening is not appropriate but the guidance on clinical assessment should be followed.
You can read Dr Jim McMorran's series of screening blogs for primary care, including a good summary on cervical screening. We also have information for GPs and practice staff on GOV.UK and collaborated with the RCGP on a cervical screening e-resource.
This blog was updated after publication to include additional links in the final paragraph.
PHE Screening blogs
PHE Screening blogs provide up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.
17 comments
Comment by Izzy posted on
Where do we report those GPs who have overstepped the line and pressurised a woman to screen after she opted out? This opt out can be very clearly seen on the medical notes.
Comment by Andrew Anderson posted on
Dear Izzy
If you are unhappy with the care you have received, there are two ways to tell the NHS what you think. You could:
Give feedback, see link below:
https://www.england.nhs.uk/contact-us/complaint/#feedback
Make a complaint, see link below:
https://www.england.nhs.uk/contact-us/complaint/#complain
I hope this helps.
Best wishes
Comment by Mrs Diana Cope posted on
I am President of Little Witley WI in Worcestershire, we are discussing the need to encourage women to take up the cervical screening opportunities offered by the NHS for our resolution this year, to be democratically voted on in May across England and Wales and brought to our AGM at Bournemouth in June. One of the questions is what could the WI do if the resolution is passed. perhaps you may consider what help we could be to the national campaign and forward me some ideas for early May to add to our discussions. thank you, really good timing.
My own thoughts are that the word Smear is not helping your objectives, in this social media word a smear campaign is not very enticing.
Comment by Andrew Anderson posted on
Dear Mrs Cope
Thank you very much for your post and for highlighting the issue of cervical screening amongst your members. Clearly, it would be tremendous if the WI were to lend its support to the campaign.
Some initial thoughts of ways in which you might provide support are through your social media channels, PR activity and distributing campaign materials such as posters and wallet cards.
You may find it helpful to look at Public Health England’s Campaign Resource Centre, where you can order the campaign materials and download the PR and Social Media toolkits.
These give advice on how to promote the campaign through your own channels including, for example, information on the campaign, useful facts and statistics, draft copy for articles, sample tweets and Facebook posts and other assets for online use.
https://campaignresources.phe.gov.uk/resources/campaigns/85-cervical-screening-campaign/resources
If it’s appropriate, we may be able to provide a speaker or set up a stand at the Bournemouth AGM.
Regarding your comments about the word “smear”, I should point out that the “Cervical Screening Saves Lives” campaign avoids the use of this term. It instead refers to “cervical screening”, which accurately describes the procedure, is clear and encompasses how it is a vital preventative test which can identify potentially harmful cells and treat them before they have a chance to develop into cancer.
The term “smear” derived from the process previously used where a swab was “smeared” across a glass plate, but a different process is used these days.
Best wishes
Comment by Kurun Coonjobeeharry posted on
A patient tested positive for high risk HPV and had high grade dyskaryosis last year, needing colposcopy. This year she is HPV negative and has been advised to repeat the smear in 3 years in view of her previous history. It is unclear how she is HPV positive one year and negative the next. Is it because colopscopic treatment eradicated it?
Comment by Andrew Anderson posted on
Dear Kurun
Thanks for the comment.
You are correct, treatment at colposcopy will have removed the HPV infection and the abnormal cell changes.
Best wishes
Comment by Sarah posted on
Surely the patient's immune system could have cleared the virus. A colposcopy is simply an examination and does not necessarily involve any treatment. The information sent to women about cervical screening suggests there is no cure for hpv, just monitoring to see if any cell changes take place. What treatment could the patient have had to clear the hpv?
Comment by Andrew Anderson posted on
Dear Sarah
Thank you for your comment.
HPV is usually a transient virus that most people will clear with their immune system. However, when the HPV virus persists, it can cause abnormal cell changes. We only provide treatment if the HPV virus is associated with abnormal cell changes.
As the HPV virus affects the tissue layers, the treatment is localised to the cervix and this is undertaken at colposcopy.
Best wishes
Comment by Jeraldine posted on
What happens to men who have a cervix?
They are no longer part of the national recall system and GPs are not contracted to keep a separate register.
Does this put NHSE/PHE/PCSE foul of anti discrimination laws?
Comment by Andrew Anderson posted on
Dear Jeraldine
We have done a lot of work with the LGBT Foundation and other organisations to make screening more accessible for trans people.
For instance, we published a leaflet with <a href="https://bit.ly/2tMgXFo">screening information for trans people</a>.
And we’ve just published a blog to highlight how <a href="https://bit.ly/2Z1p11v">local NHS services can better support trans people</a>.
In terms of screening invitations, if trans men aged 25 to 64 are registered with their GP as male, they won’t automatically be invited for cervical screening. Trans people can ask to change their gender on the NHS systems, but it’s really important they have a conversation with their GP to ensure cervical screening continues to be offered by the practice.
Best wishes
Comment by Jeraldine posted on
I'm still not convinced that the GP is meant to hold a separate list of men who need cervical screening.
I'm pretty certain their contract is to offer to screen women who have been called for screening by PCSE
Comment by Susan posted on
I too was shocked to be refused a cervical smear test today ‘because I am 70’. I am appalled that older women are being denied screening in what is obviously a cost cutting/ money saving policy .
I have previously had 2 lots of abnormal test results with precancerous cells found and colposcopies with both, one in the early 80s, and one 18 years ago , and I was told that I should always come back for a test if I was concerned. I had tests every year for ages after these episodes.
I believe that older women are not being offered cervical smears as routine because of their age, with no further investigation of their medical history. I had to insist firmly on an appt with a practice nurse when I phoned my Gp. i could have been fobbed off by the receptionist on the phone who clearly said you’re over 70 you can’t have one. I know it is not in the job description of a receptionist to pre-select women for smear test appts .
Where is the evidence base for this age discrimination? I’d like to know where To find the stats. Is an arbitrary line drawn - strangely at 65, retirement age- to save money ? Or is it because policy makers believe that even if we do get cervical cancer at my age, we will probably die of old age before the cancer kills us?
And lastly , I was told I could always get my smear done privately ! Having worked full time and paid tax and contributions for over 45 years, I consider myself as having already paid for the treatment I get in my old age .
Comment by Andrew Anderson posted on
Dear Susan
Cervical cancer usually develops very slowly, therefore it is highly unlikely that women over 64 who have been regularly screened will go on to develop the disease.
In older women, the effects of the menopause can cause the test to be more uncomfortable and make it more difficult to get an adequate cervical screening result.
We would always recommend that women are aware of the symptoms and report any changes to their GP straight away. You can find out more about what to look for here: https://www.nhs.uk/conditions/cervical-screening/when-youll-be-invited/
I hope this information will provide you with some reassurance.
Best wishes
Comment by Maureen Steer posted on
Why am I not permitted to have a cervical screen just because I’m now 68 yrs, I’ve always had them imagine how shocked I was when denied.
Comment by Andrew Anderson posted on
Dear Maureen
You'll usually stop being invited for screening once you turn 65. This is because it's very unlikely that you'll get cervical cancer. There's more information about this on the NHS Website https://www.nhs.uk/conditions/cervical-screening/when-youll-be-invited/
Best wishes
Comment by Georgina posted on
How do I find out when HPV testing will be available in my area? When I tried to discover this last month, our local GUM receptionist was completely unaware of any such testing or where I could find information.
Comment by Andrew Anderson posted on
Dear Georgina
For the list of providers of cervical screening in your area, I would suggest contacting your local NHS Clinical Commissioning Group (CCG), as they should hold this information.
The NHS website provides a directory of sexual health services in England
https://www.nhs.uk/service-search/sexual-health-information-and-support/locationsearch/734
Alternatively, the CCG for your area may be able to help
https://www.england.nhs.uk/ccg-details/
Best wishes